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Kaiser Permanente Senior Advantage Choice North (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Choice North (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Senior Advantage Choice North (PPO) in 2026, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Choice North (PPO) is a PPO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Northern Colorado. The overall rating for this plan is not yet available for 2026.
It's important to know that Kaiser Permanente Senior Advantage Choice North (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Kaiser Permanente Senior Advantage Choice North (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Kaiser Permanente Senior Advantage Choice North (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $7.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Kaiser Permanente Senior Advantage Choice North (PPO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order. Tier 2 generics also offer no copay via standard mail order, while Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. Higher-tier medications require copays or coinsurance depending on the drug tier and pharmacy type. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply at preferred pharmacies and standard mail order, whereas Tier 4 non-preferred drugs require a $100 copay. Specialty medications in Tier 5 are subject to a 33% coinsurance across all pharmacy options, including preferred, standard, and mail-order services.
Additional Benefits
The Kaiser Permanente Senior Advantage Choice North (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits, telehealth services, and routine preventive exams. For specialized care, members pay a $35 copay for specialist visits, while inpatient hospital stays require a $350 daily copay for the first six days and no copay for days seven through ninety. Emergency care is available with a $130 copay, and outpatient hospital services carry a $350 copay, with neither service requiring coinsurance. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copay, alongside annual allowances of $500 for dental care, $250 for eyewear, and $300 for hearing aids. Additionally, home health services and over-the-counter items are covered with no copay, while skilled nursing facility stays feature no copay for the first 20 days. Durable medical equipment and Part B drugs are covered with no copay and coinsurance ranging up to 20 percent.
Inpatient Hospital See details
Inpatient hospital services are covered by Kaiser Permanente Senior Advantage Choice North (PPO) with no coinsurance and a copay of $350 per day for days 1 through 6, and no copay for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers outpatient hospital and observation services with a $350 copay and no coinsurance, and ambulatory surgical center services with a $225 copay and no coinsurance. Outpatient substance abuse services require a $15 to $25 copay with no coinsurance, while outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Kaiser Permanente Senior Advantage Choice North (PPO), featuring a $375 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered, offering up to 18 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are immediately admitted to the hospital. Urgently needed services require a $45 copay with no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $45 for urgent care, $130 for emergency care, and $375 for emergency transportation.
Primary Care See details
Kaiser Permanente Senior Advantage Choice North (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits and opioid treatment require a $35 copay and no coinsurance. Physical, occupational, and speech therapies have a $30 copay and no coinsurance, and mental health individual sessions cost a $25 copay (group sessions are $15) with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) preventive services are partially covered with no coinsurance and generally no copay, including annual exams, fitness benefits, and remote access, though kidney disease education has a copay up to $35. Sub-services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Kaiser Permanente Senior Advantage Choice North (PPO), offering Medicare-covered exams for a $10 copay, routine exams and fittings with no copay, and no coinsurance. Prescription hearing aids are covered up to $300 annually with no copay or coinsurance, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) partially covers vision services, offering routine eye exams with no copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, features no copay and no coinsurance up to a $250 annual limit, though eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Kaiser Permanente Senior Advantage Choice North (PPO), as orthodontics and other preventive dental services are not covered. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered services like oral exams, cleanings, and x-rays have no copay and no coinsurance up to a $500 annual maximum.
Home Infusion bundled Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, require between no coinsurance and 20% coinsurance, while Part B insulin carries a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers dialysis services with no copay and a 20% coinsurance. A referral is required to receive these covered services.
Medical Equipment See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, subject to prior authorization. DME and diabetic supplies feature no copay, with DME coinsurance ranging from no coinsurance to 20%, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Diagnostic procedures, tests, and lab services have no copay, while radiological services require copays of $15 for outpatient X-rays, at least $35 for therapeutic radiological services, and at least $70 for diagnostic radiological services.
Home Health Services See details
Home health services are covered under the Kaiser Permanente Senior Advantage Choice North (PPO) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Kaiser Permanente Senior Advantage Choice North (PPO) with no copay, no coinsurance, and a required referral. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a referral and prior authorization. There is no copay for days 1 to 20 and days 54 to 100, a $203 copay for days 21 to 53, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) offers partial coverage for other services, featuring over-the-counter (OTC) items with no copay and no coinsurance, and non-Medicare covered durable medical equipment (DME) with no copay and 0% to 20% coinsurance. Acupuncture, meal benefits, and Naloxone are not covered under this benefit.
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